Health governance: principal-agent linkages and health system strengthening
Health governance: principal-agent linkages and health system strengthening
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DOI：
10.1093/heapol/czs132
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发表时间：
2014-09-01
影响因子：
3.2
通讯作者：
Bossert, Thomas J.
中科院分区：
文献类型：
--
作者：
Brinkerhoff, Derick W.;Bossert, Thomas J.
人们日益认识到，治理是卫生系统业绩的一个重要因素，但在概念上和实践中，人们对治理的了解仍然很少，对其作用是什么以及如何解决其弱点往往存在模糊和相互矛盾的概念。卫生治理专题讨论会的这篇综述文章提出了一种卫生治理模式，重点关注卫生系统中社会行为体的多样性、它们之间的角色和责任分配以及它们履行这些角色和责任的能力和意愿。这一重点突出了行为者之间的委托-代理联系以及由此产生的对善政和卫生系统业绩的激励。讨论确定了三个脱节，构成了卫生系统加强干预措施的挑战，目标是改善治理：（1）良好的治理议程和现有能力之间的差距，（2）正式和非正式治理之间的差异和（3）忽视社会政治权力的动态。文章总结了研讨会上的三个国家案例，并重点介绍了其治理成果：中国的卫生部门改革、巴西城市卫生资源的财务管理和莱索托医院的预算改革。最后几节说明了这三个案例如何应用该模式的委托-代理联系，并强调必须填补问题诊断与制定实用指导之间的差距，以支持“最合适”的解决办法，并考虑到加强卫生系统的政治现实。
Governance is increasingly recognized as an important factor in health system performance, yet conceptually and practically it remains poorly understood and subject to often vague and competing notions of both what its role is and how to address its weaknesses. This overview article for the symposium on health governance presents a model of health governance that focuses on the multiplicity of societal actors in health systems, the distribution of roles and responsibilities among them and their ability and willingness to fulfil these roles and responsibilities. This focus highlights the principal-agent linkages among actors and the resulting incentives for good governance and health system performance. The discussion identifies three disconnects that constitute challenges for health system strengthening interventions that target improving governance: (1) the gap between the good governance agenda and existing capacities, (2) the discrepancy between formal and informal governance and (3) the inattention to sociopolitical power dynamics. The article summarizes the three country cases in the symposium and highlights their governance findings: health sector reform in China, financial management of health resources in Brazilian municipalities and budget reform in hospitals in Lesotho. The concluding sections clarify how the three cases apply the model's principal-agent linkages and highlight the importance of filling the gaps remaining between problem diagnosis and the development of practical guidance that supports `best fit' solutions and accommodates political realities in health systems strengthening.